Welcome to Pushing The Limits. The show that helps you reach your full potential, with your host Lisa Tamati, brought to you by lisatamati.com.
Lisa Tamati: Hi everyone and welcome back to Pushing The Limits. Today I have another exciting episode for you. I have a gentleman by the name of Richard Little who is the CEO of exsurgo.com. Exsurgo is a neurofeedback company. They have developed this wonderful neurofeedback device that is going to be helping, probably hundreds of thousands of people around the world with chronic pain. Very, very interesting new cutting-edge technology. Richard himself is a multi-award-winning inventor and engineer with numerous patents to his name. In the past, Richard has held a range of different directorships in C-level and other senior positions in a range of engineering, military, and medical businesses. He's one clever man.
Richard’s previous enterprise, Rex Bionics, was listed in an IPO in 2014. What they did was create the exoskeleton, which is absolutely amazing. I have seen what the exoskeleton can do for people who are in wheelchairs or who have things like multiple sclerosis, so he’s an absolutely amazing inventor. Now he's combined the exoskeleton with a neurofeedback. What I was absolutely enthralled to see on one of the videos, was that they have now control the exoskeleton with thoughts. Not actually having to use your hands or anything like that; they can control it with thoughts. Just think of the possibilities that this is going to open, that open up in the future. This technology has also been used in stroke and rehabilitation for people with aneurysms and strokes and disabilities. I'm really, really excited for this bio-medical technology that's coming on board. I'm going to be having some, a fair few of these interviews, I think in the future, around this exciting area of exponential technologies that are coming on board. I do hope you enjoy this interview with Richard Little from Exsurgo.
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Hi everyone and welcome to Pushing The Limits. I'm super excited today. I have an amazing gentleman with me who's going to share some mind-blowing stuff. I have Richard Little sitting up at Auckland. Aren’t you, Richard? So welcome to the show.
Richard Little: Ah, indeed. Thank you very much, and it's a pleasure to be here. Pleasure to meet you. And mind-blowing: what a great pun to start the show with as well.
Lisa: Now Richard, how would you describe yourself? Like, your body of work and what you've been working on in the last decade or so is just absolutely fascinating. But I don't want to, sort of, take the words out of your mouth. Can you give the people a bit of a background in what you do?
Richard: Usually, I say dumb engineer. What we're trying to do is through some history, which your personal history, which inspired me to get involved more in the medical space, I'm an engineer; I'm not a clinician. So what we try and do is bring our engineering skills into that field. We try and actually, our kind of basic mission is to make life easier for clinicians and patients while getting a better result and saving money. If we can do those things, then we've done something fantastic.
Our most recent work has been in the field of neuroscience, which I’m very connected with. It's all about rewiring the brain. This time, what we've done is we've invented a brain-computer interface that reads the electrical activity in somebody's brain. We use that as an input into simple games, which are neurological exercises really, but they're in the form of games; the patient sees them. That helps retrain their brain. For something like chronic pain, we're actually able to treat that chronic pain and actually, we're as efficient as prescription drugs that people would use, but none of the side effects or anything else. We have a massive effect on things like sleep, and anxiety, and depression as well. We're expanding our knowledge in that space. We're hopefully bringing that out to the market next year as a commercial enterprise.
Lisa: Wow. And so the company is called Exsurgo. How do you pronounce it correctly?
Richard: Yeah, it's Exsurgo. It is like to rise, to recover, which we thought was very appropriate, but nobody can pronounce it. I think the aliens pronounce it eksugo. We say Exsurgo.
Lisa: Exsurgo. This is a neurofeedback device that raises, measures the brain waves or the electrical activity in the brain, and then helps people to train because neurons that wire together, have neurons that fire together. You're basically training your brain not to actually respond to these pain impulses that are coming through. Is that how it works?
Richard: That's pretty much it. I mean, we know that your right neurons that fire together, wire together. It’s what these clinicians would say, and we know that you can retrain somebody after they've had a brain injury, after they had a stroke, that kind of thing. That's well-understood science; it's called neuroplasticity. What we do is we use that very same principle, and it's kind of like, it's called olecranon operative conditioning. But it's like classic conditioning, where we positively reward somebody when their brain makes changes in the right direction.
The headset that we use, neurofeedback, has been around for a long time. EEG, electroencephalogram, which is what this case is, has been around for nearly 100 years. 1924, there was a German chap called Hans Berger, who stuck a voltmeter effectively in his son's head and measured electrical activity. By 1927, they were actually using that for medical purposes. If you go into any major hospital or clinic in the world, there's any EEG device there. And they use it for diagnosis and things like epilepsy, and looking at sleep patterns, and even for brain death for somebody whose, who may have trauma. That's a well-understood principle.
Through some science that was done within fascinating history. But through some science, about 50, 60 years ago, there was some work done to show that you can actually modify those brain patterns and you can actually do that for good. And what we're concentrating on is chronic pain. How we kind of think of it is, how I think of it, my simple engineering terms is that there's two types of chronic pain that I think. There are many more. But simply, if you have an injury, a tissue injury, so you injure your shoulder, I injured my shoulder in kayaking a few years ago. I thought I was still 18 I'm not, apparently, and carried on as if I was, injured my shoulder. It's painful, I don't move it. There's pain signals there in my brain.
In fact, there is no such thing as pain sensors in the body. It's warning signals, its heat, temperatures, pressure, it's all those things that the brain interpret as pain. That really is like a fire alarm saying, ‘Don’t move your shoulder.’ That's a good thing, right? Because we want to preserve that tissue. So what happens with some forms of chronic pain is after a period of time the tissue injury has healed, but the fire alarm is still going off, and that could be that you're mistaken pressure for pain, etcetera. In that case, there's no ongoing injury.
Then there's the other type of pain that they think of which is something like, say arthritis, where you have an ongoing tissue injury, if you like, where there's pain being caused all of the time. And that’s the two different kinds.
The first case, in some ways, it's sort of simpler. We deal with both but the fact is, in some ways deals that it's much easier. We take that fire alarm and actually teach people just to turn that down. In fact, most lead to turn that off, and many people will get a complete sensation of pain. What we do is we measure with that simple headset and different locations on the brain. Those little black dots are sensors that read the electrical activity that's happening in the brain to transmit that to a wireless device, either iPad or phone.
We would use the electrical signals as a game. So they are always fluctuating. When you look at the screen, you will see these and we do things like jigsaw puzzles, or a balloon race in the sky, or simple paragraphs that are very focused, psychologically constructed, I supposed, games. Those games will move in time, in real feedback time with the electrical signals in the brain. The brain actually makes a connection between what's happening inside itself and what's happening on the screen. Every time the pain signals, if you like, are turned down, you get rewarded on the screen, and the brain loves that reward right? Same thing and it keeps reacting to this positive reward. That has the effect of clinically turning down people's pain. We're talking about, 70, 80, 90% of the people who are doing this are actually getting reductions that are clinically significant in their pain, greater than a lot of drugs, better than medications. If you know anything about pain medication, it's horrible.
Lisa: Oh it’s horrible.
Richard: I'm so glad we have it; you really want to have that stuff. It's a fantastic tool. This is another tool. It's no, it doesn't replace everything that's out there. But you know, look at the opiate crisis and all that sort of stuff, anything that knows pain pills, they need real management. There's lots of side effects; there's lots of issues with them. If you're not across that management, then it's really difficult to get them just right. That's actually what we see with our chronic pain patients: it actually takes generally many years for them to get to a pain specialist. So what happens is, people are in pain, they'll go to a family practitioner who prescribes some drugs. They'll try again, they'll try again, try again. They'll try physio. And these people end up bouncing around in the healthcare system for ages, consuming vast quantities of resources and not getting the relief that they need. It's actually one of the most expensive, if not the most expensive, health care issue.
Lisa: Yeah, so pain is worse than cancer and heart disease.
Richard: Cancer, heart disease, diabetes. Yeah. I mean, US, it’s $635 billion a year. In five countries, being the US, UK and European countries, it's a very $1.8 trillion a year problem. Imagine if we could get that money back into the health system.
Lisa: Amazing. Yeah. If we could actually ease the suffering, I mean, I've just come through a bout of shingles. I had shingles, and it took me, it's been two months now. I'm only just coming out the other side and the pain signals, I knew that there was a time when the virus had actually done its thing. It had finished but I was still receiving the pain signals. Now I've still got, like numbness, in that area. Having that chronic pain for that period of time really made me very empathetic to other people who have constant pain because it's horrific. When you don't have a way out, and I'm very reluctant to take painkillers because I know the side effects. But there were times when I just could not stand the pain, and I had to grab to them, and then they didn't really work.
I was doing in my, very limited knowledge of what to do. I was doing my breathing exercises. I was doing my meditation. I was trying to distract my brain because what I was fearful of was that the brain would create this chronic pain signal and then I wouldn't stop having that signal. I would do things like go and have an ice cold shower in the middle of the night just to break that pain signal. I don't know if that worked or it felt like it worked. But it is that sort of thing that you're dealing with you when you actually can break that pain signal by retraining your brain not to actually experience it?
Richard: Yeah, absolutely. So I try to think of the pain stuff as a negative feedback loop. It's a negative feedback loop that brains go into but also sort of becomes that across people's lives as well. What they'll tell us now is, ‘I don't have chronic pain’, fortunately. But what they'll tell us is because of their pain, they struggle to sleep, when we struggle to sleep, that's a form of torture. Then that affects their mood because you're not sleeping, and then you end up with anxiety or depression. Then you're anxious about doing things because you don't want to cause yourself more pain. So as you start doing the things that you love doing, and the things that are important and meaningful to you: family, friends, hobbies, that kind of thing. It tends to make people's world negative and smaller.
If we can relieve, and this is where it works for the second group of criteria that I was talking about, where you might have an ongoing injury. We're not going to solve arthritis by turning down these pain signals. But what we can do in both cases is when you turn down the pain signals, people do the things that are good for them. We all know what's good for us right? Now, you've not got that pain, you get a better sleep. When you get a better sleep, you get better mood, and you get better mood, and less pain, and a better sleep, you will go and do those things that are meaningful and important to you. That lifts your quality of life. That lifts your moods, which then lift your pain.
You just find yourself in this virtuous circle, I think of it, and you spiral up instead of spiral and down. It's sort of as simple as that. There is lots of physical effects with it as well because the brain is very much, our neuroscientists would say, it's very much like a mesh or a net. When you pull in one part of that net, you’ll effect others. For things like the arthritis, we were very, very surprised, we do not know that we've done further research into it. But originally surprised to see that swelling, for example, what information would go down, because the area for inflammation sits underneath the pain area of your leg or the pain. When we call them that, and we're able to reduce inflammation, then you allow people to do those things, and they laugh more. You've not just got an electrical change and biochemical change in the brain, we actually have this physical change in their bodies as well. And then–
Lisa: Does it hit the inflammation just in the brain or in the body as well?
Richard: In the body as well. Our favourite story, I think it might be in our website, is that of the lady with psoriatic arthritis. I don't know much about it, but it gives people what we call sausage fingers. The fingers are so small and they can’t use them. This lady who was on a trial, we did a trial last year in the UK on this, we have another large trial running just now in New Zealand. Back in the UK and some other trials and other things as well, we'll come to you.
She was a school headmistress; her passion was writing. She couldn't write because her fingers were so swollen. She basically just couldn't bend them; she couldn't use them. Medication, by the way, that you take for that condition is horrendous. The side effects are horrible. We say it's like having leukemia. She chose not to take the medication because the side effects are so bad. Actually, we see that with a lot of people who come to us. They've tried everything and a lot of people will just avoid that medication if they can and suffer the consequences. None of it's good. There are times for taking the medication, but they'll often know. For her that reduction and the swelling in her fingers allowed her to go back to her real passion, which is writing. This is a brilliant thing to see happening. That physical change, to see that swelling reducing and somebody is now– We were messing with the brain and physical changes in their body.
Lisa: Well, this is the master command, isn’t it? I mean, if you can affect some of those inflammatory pathways, and yeah it would affect the body. So let's just–
Richard: They affect everything. I mean you're smiling just by that. If I asked you to describe how you did that you wouldn't be able to tell me. It's all these complex, electro biosignals that are coming, chemical changes in the brain. It all happens in that split second. We know very little about this. I like to think at Exsurgo, we would know quite a lot. There was one scientist in Europe who said, ‘We're one inch into a one-mile-long journey, and maybe even a longer journey than that.’ There's a law of unknown in what happens with the brain and how all of this stuff works. In fact, we find ourselves now doing this work at the sort of age of that science. There's lots of things we'll try and read up on that are not in the literature. We're out there, pushing the edges of this, pushing the boundaries as much as we can.
Lisa: So, Richard, you've got a bit of a story. If you don't mind sharing because we were talking prior to recording, I was telling you about my mum and how I managed to get her back to full health after a massive aneurysm and stroke. You had a mum who had a stroke as well. Can this technology be used for people like stroke rehabilitation? If they've got aphasia, or upper limb problems, or walking problems even? I'm asking for selfish reasons, obviously.
Richard: Absolutely. I did have a mum who had a stroke and I do have that story. Yes, we can affect stroke in different ways. We're actually setting Exsurgo to be a stroke rehabilitation company and to develop equipment for stroke rehabilitation. We were always doing these brain-computer interfaces. We actually, sort of, pivoted a few years ago because this pain issue particularly was something that's so large, like it's the largest health issue that we face. But we still do a lot of strokes. That will find its way to the market next year. It’s pretty exciting what we do there.
But the story, to kind of go back, I'm an engineer by DNA. It's me. It's my life. I fix things. I make things that's when I'm happiest: to build things, saw problems, really. I worked in the offshore oil industry. I was a marine engineer and commercial diver. It's the connection with hyperbaric. Yeah. I did that for 19 years nearly and it was fantastic training. When you work offshore, you work 12 hours a day, seven days a week. You do months in. And if things are going slow, you are harder because there's so much money involved in all of this stuff.
It was a really good sort of grounding for me moving forward, but it's wet and cold offshore often, so you want to get into an office somewhere. And I was more inspired really by things that were high tech, really, rather than the heavy engineering. Although I love heavy engineering too. I find myself on the board wandering across all these different industries from automotive, and military, and actually touching on medical as well. I was part-owner and commercial director of a medical centre here in Oakland. We had a hyperbaric chamber and because of my diving background, that made sense to me. We were doing training for athletes within–
Lisa: Is this still going by the way? Because–
Richard: I don't know. It changed hands many times after I left and I'm not sure. I need to look it up, actually, now you say that. We were doing hypoxic training, as well, for athletes. These hypoxicator machines that would strip oxygen from the air to for altitude training, of course, great stuff. Then my mum had a stroke, completely by surprise. She was 71, 72 at the time, and a fit woman, walked every day with our dogs, complained to me. It was surprising she would have a stroke, never thought of it. She was across Scotland where I hail from and I was here in New Zealand. 36 hours later, I find myself in a hospital in Fort William where I’m from. And she’s just lying there and it's just complete shock. She was in shock as much as anything, as we were, knew nothing about stroke. I knew nothing about the sort of journey that faced, was ahead of her in the face.
It was very simple things that struck me quite quickly than the two-handed things. I told her when she tried to brush her teeth, suddenly you're a patient; you're sick; you’re needing the hospital. The simple things like grooming are so important. She went to brush her teeth and suddenly she can’t get the top of the toothpaste because you need two hands and simple, but so important. This upper limb problem, and we never really resolved a lot of the things where she was affected. Cognitively, she was relatively happy.
Afterward, she said to herself ‘I'm an old lady now and that's fine.’ She wasn't really interested in doing too much rehab. She did enough that she was, could get to the bathroom herself. You could– and her and dad would go on holidays and things. So she was relatively happy with where she’d got to. I didn't think any more about it than now. I had to build some ramps and handrails and things around her house to help her, try to functionally help her, as much as they could but didn't think too much about rehabilitation.
And about that time then, my friend Robbie, who we've been friends with since we were kids, and he was diagnosed with MS, multiple sclerosis. As a child with MS, he’s likely to need to use a wheelchair. His mum had MS, his dad has MS and uses a wheelchair. We've kind of been brought up with that. I had been building robots at the time.
Lisa: As you do.
Richard: Robots, you engineer them. ‘So, look at you. Let's build you a set of robot legs.’ We didn't think any more about it than that. He's an engineer. We started this crazy conversation. We're both in the UK at the time. We came back here and we said we're going to build it. We're still talking about it, right? So let's build a set of robot legs. We thought it was about mobility, and mobility is really important. If you think about what you’ve done in the last 24 hours, imagine trying to do that in a wheelchair.
Actually, we found that there’s this bigger issue of the secondary complications of being in a wheelchair: bowel, bladder, sexual function, all this stuff. Not sexy but it really affects people's lives. And the opposite of sitting as walking. So the exoskeleton robot that we started building was something that would get people up out of a wheelchair. It was a kind of operate mobile. It could walk.
Lisa: It’s crazy. I’ll link the video to it because it’s pretty awesome.
Richard: It's great. For people with that, they would have more control over some of their bodily functions. And that they would be able to, maybe they could walk. And they were using it as a sort of stable platform to learn to re-walk after a stroke. There's a whole load of different applications for that technology. Yeah, that was amazing. But boy, it did to me was that really, I spent 20 years. That's 20 years ago, now that we started that project, really now. I spent 20 years in clinics and hospitals all around the world, with these various technologies, and the clinicians kept saying to me, ‘Richard, you're an engineer, can you make me insert the name of a medical device here?’
The issue that was really are the issues that really affect them is, we pretty much fund these things the same way that we always have done. The costs are going up with all of this healthcare stuff. We live longer. We survived things we never survived before. and our expectations are much, much higher. Unlike my mum whose happy after a stroke, a lot of people will hit Google and go, ‘I want to get this technology, or this piece of science or this medication, and I want that.’ People's expectations are very, very different from what they once were. We can't keep up with all that, that's an unsolvable problem. You can't keep applying more technologies and not save money. Then you take some of the stuff that we do with hearts, for example, it costs tens of thousands of dollars to do something for somebody, a heart function. Then that might be something that’s replaced within a few months. And these are expensive things, right? We get them, but somehow or another, we need to fund them.
So my idea was if I can make the clinicians’ life easier and the patient's life easier to fit into both of their workflows, their daily lives, while getting a good result and saving money, then we had something that would be worth doing. I'd also spent a lot of time working in various universities around the world, too. And actually, New Zealand has some of the bests in rehabilitation. AUT and Auckland are fantastic places, other places in the country too. But here's a whole lot of science that I was talking to the scientists about that they had a whole lot of understanding. They had that clinical process of recovering from something like a stroke that affected my mum, and what they needed was devices and a way to get that stuff out to the market. So that's where we can apply our understanding and build devices.
There were actually quite a lot of devices in stroke already. But like the exoskeleton, which is always sort of seen as a kind of showing people what we could do and what we're capable of. It was like kind of leading piece of technology. What you really need to be able to do is not have these expensive devices in a hospital, because if you've had a stroke, or you have chronic pain, getting it in the hospital’s no good, you got to get it at home.
So let's make these things as inexpensive as we can. Let's use gamification so that we can engage people because we all know what it's like when you have exercises to do by the doctor or the physio. We don't want to do them. So gamification actually really helps with that. Our ideal, and mostly what we do is a subscription model, so we make these things relatively as inexpensive as we can. We've got a lot of costs we have to cover, but we try and make these things as low risk for somebody to get into as we possibly can, and do your rehab at home.
With the technology, of course, the clinician can have visibility of that. If you're using a device to try and recover from a stroke, or if you're using Axon to try and recover from your pain, all of that stuff's available online. The information that comes from the handset or the device is up to our cloud server to the data. It's all secure. The clinician can log in; he can prescribe different exercises, prescribe different protocols for pain or anxiety. They get reports back; keep eye on his patients.
If the patient isn't complying, that old problem of not doing exercises, why not? Let's help the patient to fix whatever it is that’s stopping them from doing that. Let's take that if they don't want to or can't, let's take it and give it to somebody else who can use that technology and make those savings. If they're making the progress and if there's no out of condition alerts or something's going wrong or there's something abnormal, the clinician can see that from a distance. Therefore we try and tackle these problems early, too.
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Richard: When it's stroke rehabilitation, you can see lots of information in people's movement, if you're doing these, play these games, these devices to help people play the games, depending on what functionality they have. Your speed and your accuracy and your jerk and your acceleration and deceleration. All these things are very meaningful to us in diagnosing where somebody’s at. And if it’s Axon, the data there is so rich, even more so because you're looking at somebody’s brain function. There’s huge data coming off this. But also that data has a lot of information in it. Think of it: over a certain age, 5% of the population will have undiagnosed dementia. When you pick up that dementia early before they even know they have it. Start treating it before they know have it.
Lisa: Can you do that? Yeah, it was coming. I've got so many questions for you. Are you aware of the work of Dr Peter Diamond? He's–
Lisa: You might have to, I have to connect you. He is in charge of Abundance Digital, and he's written a number of books, but one of the books is called Abundance and another one is The Future is Faster Than You Think. It's all about these converging technologies and these exponential technologies and how it's actually coming all together now so that we can get all this big data. We can actually, like he says, that these exponential technologies that we're dealing with are able to– they go through phases of being deceptive, disruptive, dematerialised, demonetised, and democratised. Meaning it starts off really, really expensive, and then it gets cheaper and it becomes very disruptive in the industries depending, on you know.
He has a company called humanlongetivity.com, which I have this vision of having that down here. Like getting a group of people in the medical engineering biotechnical space together to create a one-stop sort of warranted fitness shop. Okay, so if you can stick with an analogy for a second. Yeah. You know how you take your car in for warranty every year, and they do a like check all over? Well, I sort of see an institution or a place where we go, and we have like a half a day or a whole day set of screening.
Now there's new MRI technology coming out. It's going to be 1000 times cheaper than the current stuff that we have, that we're actually going to be able to have in the home eventually. And then, we’ll be able to scan our entire bodies and tell us ‘Hey, you've got pancreatic cancer brewing.’ Or ‘You've got a bone density issue.’ Or whatever the case may be. Then you go through echocardiograms and coronary stuff and you'll be able to look at your, obviously, your blood markers and all of these things all in one place in one, sort of, setting. That you go through for maybe five or six hours, and then the data that comes off there will be able to then prevent people and get this early. When you said that, I just went ‘Oh my god.’
Richard: That’s what we do.
Lisa: Yeah. Because if we can fix this before it happens, if you can see that aneurysm that blew my mum's head six months out before it happened, two years out before it happened, at the moment, I have to go and push and fight to get another MRI, to get it checked every three years. And we keep getting forgotten about in the system. All of these types of problems that come with the way it's currently set up. If we had this fitness place, wouldn’t that be amazing?
Richard: Yeah. The way that we sort of see that is that we have– there's so much information in the brain, and there's so much that's happening. We're not even aware of what might be able to be picked up now. We had, in our clinical trials last year, we had a woman with glaucoma, and we were able to see an abnormality in her EEG, in her brain electrical activity that pointed us to something being wrong. We find out that's what it was.
Lisa: Oh my gosh.
Richard: Even the pain thing. So we're right now, you go to the doctor, and you go about some pain, and he says, ‘Is it sharp or dull?’ Where is it? And what is on a scale of 1 to 10?’ I mean, how unscientific is that? Anxiety, depression, where are you on these sort of scales? And what kind is it? What kind of pain or what kind of anxiety, and what works best for that. All these things, all that information is sitting out there and then we can tap into that now. We even know that being able to even predict who will get pain. There's been quite a bit of work done on that. That's a really important thing.
There’s a couple of surgeries, particularly the hospital we're working with, they'll sit to tell you that breast cancer surgeries and knee surgeries are two of the surgeries that you have a lot of ongoing chronic pain after them. The goal here is to actually be able to predict who will get pain after their surgery and treatment before it even happens. That's the idea, that’s the dream is that we pick all this stuff up in the brain, we're able to diagnose it accurately. We're able to put some numbers around it. We're able to pick different times, pick different therapies, whether it's the therapy that we're doing, or it's a drug therapy or combination, or whatever it is.
Richard: Yeah, try and cover all those costs.
Lisa: This is just next level. When your technology, what we know, right now is all about the pain. But this is got like–
Richard: The pain, anxiety, depression that we qualify based on just now that we're focusing on. We've got about eight or nine trials this year that are kicking off. A large one in pain, with a couple of different arms on it, the anxiety trials that we have going in the UK and the US this year as well. Then also concussion is another thing that keeps for us as well. We're looking at concussions. The concussion thing, again, it's a big issue, there's lots of money, and financial and legal issues around, actually seeing that professional sports problem. Our thinking here is that we would be able to diagnose concussion at the side of the patient. Somebody is knocked out, they go to the hospital and they get treated accordingly. Generally speaking, it's the people who slip through that net. They don't– they're not unconscious, they go back on and play or they don't, whatever it is. There were some of the clinicians were telling me it takes an average of 30 days to diagnose somebody with a concussion.
Richard: Then you've got a multiple-year problem.
Lisa: Yeah. We're not even like– because I do a lot of work with concussions. Because I had a clinic as well, which I’ve now also sold, but there we had that program on Sunday the other week. Not one person mentioned hyperbaric, not one person mentioned neurofeedback, and not one person mentioned supplements for brain injury, which there are many that can help. It just seems to be like, why is there this disconnect from what there actually happening in the lab to what's actually been offered in the clinics and the hospitals? Why do the doctors and techs not know about any of this information?
Like those friends that you mentioned on the neuro stuff, rehabilitation. When my mum had her aneurysm, which is five years ago now, I was never offered or told, and I’ve been like I’m in this space now and I still don't know some of those connections that you're talking about up there, which I'd be really interested to have. Why is there this disconnect between what's actually happening in the lab and what's actually happening in clinics?
Richard: Yeah, well, it's difficult. Because it is a heavily regulated area, medical, whether it's fibre logical, or whether it's devices, and quite rightly so we don't want people pushing out anything that isn’t right. It's correct that there are all these protections and regulations and all the rest of it in place. They are quite cumbersome. There is a lot of it. There's a huge amount of cost associated with actually getting something like this through.
If you take something like Axon, because it is a diagnostic device, that moves it up the classifications, it's a safe device, which helps bring it down a little bit because it's low risk. We're not actually putting anything into the brain we're measuring. But because it's diagnosing, because it's measuring and we're using that information, then that's quite heavily regulated. It actually costs many millions, more than tens of millions to actually bring something like that to the market. You've got to have somebody who is dedicated to that story to actually get it there.
Lisa: Have you done like that, if I can ask, share what you're willing to share? But how do you get backing for something like this project that you've done and for Rex Bionics, what you did with the Rexercise? How did you go about doing that? Because we need like, there is, apparently, now more money available for venture capital and things like, in the universe. But it's like, well, how do people with brilliant ideas get that support when they're not–that's not their expertise area? So how did you do it?
Richard: Well, most will fail. That's the other sad thing. Most people who try and take some of this technology to the market will fail. You're on an uphill battle from the start. It helps to be slightly mad because it would be surely easier to go to work for somebody else than to do this. But there's probably a little bit like your athleticism and everything as well. It'd be easier to give up than it would be to keep going, I'm sure in a lot of the things that you do. It's that passion, and it's that drive, and it's that connection to the patients. Once you see it, you can't unsee it. Once you know that the problem is there, you can't unknow that problem. I guess that's what drives us.
It’s actually the patients at the end of the day; we care. So we have a team of people who care and they're funded by a team of people who care. I know the first time around with Rex Bionics, we went down the venture capital route. We have investors who– they all have their own goals that they have to meet. They have their own pushes and pulls and they don't always match with the company, and that's what's most important. I think saying something like this is the opposite to shareholder alignment and finding people who actually are on the journey with you.
I was very fortunate this time, to meet some people from the Middle East. We had some New Zealand angel investors, I suppose, if you like, but they're very sophisticated angel investors who funded the company from the start. Then, I was very fortunate to meet some individuals based around the Middle East. They’re not from the Middle East but based around there who actually really loved the cause that we're on, but also can see the commercial advantages of what we do. Therefore, the money that the company could make from that, while at the same time, saving people who are suffering.
Lisa: This is the perfect combination.
Richard: It's a noble cause but also a great commercial opportunity. We should make some money from this, and quite rightly so. These investors have risked a significant amount of their personal capital to get us here. But we reckon that we could save something like, 70% of the cost, 60-70% of the cost that's associated with pain right now. Like I said, in those five countries, it's a $1.8 trillion a year problem. If they took Axon and used it for pain alone in the National Health Service in the UK, we estimated that'd be somewhere between a two and seven billion dollars a year saving.
Richard: What would you do with that money?
Lisa: Then you can allocate those resources to something else, and then it's people… Are you up against, and this is a bit of a tricky question, but are you up against powers in the pharmacological side of the industry that are against what you're doing? Because you will take a piece of the pie?
Richard: No, I don't think so. The pharma companies, we've all seen all the headlines about the opiate crisis. It's massive, and it's a tragedy, and it's a huge social issue. It's a whole program in itself plus. But the pharma companies now know that they need to do something different. The drugs they make, the pain drugs, they’re fantastic; we need those. Glad to have them in the toolbox. They were overused and overprescribed. There's no question about that. They know they need to do something different now. You actually see the pharma companies investing quite heavily in this digital medicine space as well.
I think it's a time, this is the time when it has to change people. It was a huge wake-up: the opiate crisis, the overprescription of these things. What are we going to do different? And the pharma companies are on that same journey. Whether they like it or not, they have to do things differently. I think we're all kind of pushing in the same direction.
Lisa: Is it a bit like the auto industry, where there, the combustion engine was rolling, and then the big car companies now are actually the ones that were too slow to react and go with the electric vehicles evolution revolution? And now all coming on board, but they’re actually being beaten. They're being beaten to the punch line by things like Tesla and other tech giants now. Because if you drag the chain too long, you're going to miss the boat. You might as well, a bit like Kodak with their digital cameras. They discovered the digital camera and then didn't take it on because they thought it was a threat to their main income. So they actually missed the boat.
We've done before it. And I think you, like now, this is where I see the small entrepreneur like you guys, like, small, you're not small, but you know what I mean. Comparison to say, a Johnson & Johnson or something, actually more nimble, more able to react to the markets, more flexible. The future, looking at the future, these big cumbersome institutions, whether they're governmental or big, big companies are actually going to be slower to react than the smaller entrepreneur who’s got a crazy idea in the back of his shed doing some tinkering around.
Richard: Yeah, absolutely. I mean, I used to joke that some of these big companies will spend more on lunches than we spent developing the technology. But it's probably true.
Richard: Even still, it's still into those tens of millions. It's hard to compete in that space if you're not one of those big companies. That's not their fault in any way, shape, or form.
Lisa: No, it's just huge. This is too big.
Richard: This is a big problem to solve. Here in New Zealand, it’s actually one of the better places to develop this technology. We have a really good framework here, we have really good legislation sort of around us, we have some fantastic schools and things. So we're, obviously, I'm Scottish, you can tell from the accent, but they've been here for nearly 30 years. So you see what actually works really well as a place to develop it. We've got a few advantages down here from that. But it’s a changing time, and the people speak. People are fed up with the opiate crisis. The government then has to follow, and changes have to be made.
Lisa: This is just fantastic and where do you see this going? Then, so you're in the middle of clinical trials right now in New Zealand. Once you've gotten– are these like, phase 1, 2, 3 clinical trials? Is this going to be on the market very soon? Are we're going to be able to buy these devices? Are there going to be too expensive for the average person to be able to access? How's that gonna work?
Richard: Yeah. Well, we were in trials because trials are the value of the company. You have to have these trails behind you for the medical community to get behind great ideas. If you don't have enough trails, they're not gonna buy and play, right? We did some smaller trials last year in the UK. We got really good results from those and that's prompted larger trials now in New Zealand. We have a trial here, which is for chronic pain, which is large enough to be clinically significant, statistically significant in numbers. It's a gold standard trial. It has sham controls. The clinicians are blinded. They don't know who's been treated and not treated, so they can’t bias the outcome, all that sort of stuff.
We're in the middle of opening up another arm for that in the UK and NHS over there. So that will be multi centres for trials, which adds credibility again to it. We should be able to launch that device commercially in the market next year, early next year. We do have a, hopefully not too far away from now, being able to actually sell in the US. We're not quite ready for that yet. We need to offer production levels and things. But we're not far away from actually making our first sales in the US as it is.
The price and like I said, we're trying, we haven't fixed on that yet. But what we're trying to do is a subscription model to make it affordable. So you're paying over the month, and you're using the thing rather than one big lump sum cost upfront which is a risk for people when they don't know what they're getting. Where we can with some of the stroke devices, and may well be the clinic that wants the stroke device, and they can lease that to a patient for one month. This is a different device for a different month and that takes away that capital kind of risk for the patients as well, buying that.
Lisa: Some of these will be short-term.
Richard: Or as short-term as you need. You might want different devices to incentivise you for different times and different stages of your journey. There's a whole–we're trying to make this something that we can get out there as simply as we can. We actually got one of the large accounting and consulting firms that do some market research for us rather than Richard says, ‘Listen, how many units we're going to sell?’ A spreadsheet. We actually got one of the big four to go out and do that work for us. At the very smallest amounts of numbers that they came back with, we're swarmed. We just found a dilemma.
Lisa: You want to keep up with production.
Richard: And that's what we’ve seen. We did some stuff in the news here in New Zealand, a couple of months ago, and almost within a week, I think the trials were–we've got more people interested than there is spaces. We're getting inquiries from all around the world because of that. It is the biggest problem that there is out there, which is that, it’s chronic pain. It’s no surprise to us that those people are interested in getting it. Commercialisation next year because of the numbers.
We are a noble cause. We care for our patients. We want to make sure we've got the systems, and processes, and the people in place to be able to actually cope with that. We're actually kind of wrapping up the company right now through the end of this year. I kind of think of it as science this year 2021. Commercialisation next year–it’s not quite true because we're doing a little bit of commercialisation this year. But I think for us to beat those sales, make sure the flow of information and product and everything’s great. So that when we do on a larger scale, we're going to open up.
Lisa: You're an incredible man because you've had such a breadth of experience across. Like coming from the oil and gas industry into the bio, into Rex Bionics and exoskeletons, now over into neuroscience. What I like to pick the brains of these–I hate that word–but of these incredible people that have crossed industries who have used their skill set to go into an area where they passed.
Like, did you know how to scale a business up like this? Did you know how to go and work with hospitals and universities? You had an engineering background but how did you get your head around actually moving across industries like this and being so multi-talented, if you like, and being able to scale big businesses, work with partners and venture capitalists, and doing these things when you're one little bloke who did engineering? You know, coming from there?
Richard: There's no real answer to it, no one answer to it. It’s make lots of mistakes. Keep trying. And you don't start off on that journey. I didn't. I wasn't sitting on an oil rig one day, and so I knew I'm going to build some medical device companies, and we're into that world.
Richard: Let’s just say you've had an interesting career, and I don't even think of it. I didn't think of it as a career. I do know that I've spent 20 years in medical, and I can see that that was obviously what I was meant to do. But I had a lot of jobs but it strangely sort of weaved together. I was brought up in the Highlands of Scotland, we didn't have a lot of money. I used to make my own kayaks and things because I couldn't afford to buy them. I’d go and use up some fibreglass. Then, later on, we worked for a company that built fibreglass buses. It just went on like that. I’ve been able to build things, and shape things, and mould things. Then worked for the plastics and casings, and it's just all tied together.
But I think there's a lot of people out there, there’s ups and downs in their journey, hasn't all been successful. There have certainly been some painful parts there. But there's a lot of good people out there who are trying to do the same thing. People like yourself, who are trying to promote democratising there's medicine and things. Even within the health systems, although, gosh, they can be cumbersome. It does take time. I've had doctors banging on the table saying, ‘I want my device within two weeks.’ And two years later, we actually get the purchase order. Because it took that long to line up insurance policies, and tax systems, and you name it.
There are some really good people in there and they're trying to do good things as well, and those are the people that we work with. It’s not adversarial; you're not butting heads with these people. You're working with people that are trying to do the same thing as you. And I think that's really important. We've been very careful this time, with this company, whether it's investors we've picked who have that alignment. The scientists and clinicians that we work with have that same sort of thought process and alignment.
The trial we did last year in the UK was with one clinician by a rehabilitation centre, a new rehab centre in the Midlands. And they've got that sort of ethos of trying to take the best technology for their patients and trying to keep pushing the boundaries. We're working with people like that, who are already kind of thinking in the same way. That's what we do. If we didn't meet the right folk, we wouldn't get into bed with them, you know?
Lisa: Yeah, it's who not how.
Richard: Yeah, it's absolutely who not how. There was no cunning plan there. I suppose, at the times when it is difficult, like all the psychological side of the things that you do, it's just too important to us, personally. But we also feel that pull from the patients. It’s too important to patients. I couldn't live with myself if I gave up on this journey because patients are going to suffer. The stories that we hear, that's what keeps the engineering team going, too. The stories that clinical teams as well. The stories that they hear every day: about people being able to do things that they weren't able to do before or haven’t done for a long time. That's what drives them through. And one of the doctors actually said, recently, that's what he trained for. He trained to make people's lives better.
Lisa: Exactly, that’s the core. Every doctor’s and every clinician’s wish is to actually help their patients. Sometimes the systems were set up, and the limitations of resources, and the bureaucracy, and the box-ticking that has to go on sometimes is a hindrance. I think we’re at a time in history when things are changing very, very fast. It's super exciting to think what's coming down like, the line in the longevity space, which I'm being heavily researched into.
I'm just excited for the changes and the abilities of the little person, if you like, to actually make an impact and a dent in the universe, if you like. And to me, I want to make a change. This is why it fascinates me to interview someone like you because I'm on the same line. I’ve been an athlete, I've been a jeweller, and I've been, I've done 100 different careers. I've been an author, a documentary maker, a TV presenter, radio, you name it, I've pretty much done it. I've never even had any qualifications for any of the things here but you just bumble on in and learn on the way.
Now, when you start to look back over your own life and the pieces and things that happened to you, like my mum's journey took me into a complete new world of rehabilitation. Then trying to–and then understanding that the limitations of a medical current system and then trying to, not live in an accusatory way, but it's just the way things are. You just don't get access to things and things are not running as they should do, and there are limited resources, and so on. Then realizing there's a complete new world of research out there that is not being tapped into and then wanting to share that with the world. That's my passion now is to be able to connect the right people, help people optimise their own health, be in the care, in the prevention industry, not on the disease sick care industry. And I see that paradigm shift coming.
I'm really excited about all these technologies that are now going to be able to make it. There are things coming as we mentioned before, there are MRIs coming that are going to be so cheap, you're going to be able to have it in your home, be able to scan your own body, send it to your doctor. They'll be able to diagnose what's happening. You'll be able to do this every few months to make sure that things are on track. You don't get that stroke, and that heart attack, and that aneurysm, or that cancer hitting you out of the apparent blue when it's actually been building for a long time. You just didn't see it. This is a piece of that puzzle because EEG and neurofeedback and all of this sort of stuff and being able to look inside the brain is just–Oh. I'm just so excited right now.
Richard: We are too. To be able to do that cheaply and to do it at home and everything is there. It's a convergence of technology. It's a convergence of the market as well, because of the opiate thing. We've had enough of all of that sort of stuff but also we need to–we can't keep growing the way that we're growing. There are more and more people on the planet, and higher expectations, and living longer and all that.
We have to have that dramatic change and the dramatic changes is right now. I like to think we're the front of that. If we can have this headset home for somebody who has pain but then is able to actually pick up some other issue that might happen in there, or use it in the back of an ambulance, or on the side of a pitch, or wherever that might be. There's a lot of places where you can pair a relatively inexpensive piece of plastic with a whole load of science. And technology and good people behind it at the other end automate much of this information. You know, the EEG spaces.
We do pretty much- the machines now, they've got a little bit more modern. We pretty much did you know what it did a hundred years ago. Well, a smart device, a phone has got so much computing power on it, you can automate- looking at all of that data. The brain has always–its fixed patterns, if you like, in so many ways for so many different things. You can read those patterns and you can understand those patterns. That was actually where we did some of our early work was in thought control of the exoskeleton legs. So that somebody would think ‘Walk.’ or think ‘Stand’ or whatever it was, and actually be able to move the exoskeleton around. So, that’s really happening.
Lisa: Really happening. Yeah, brain, computer interfaces are already there.
Richard: It is a brain-computer interface, that's what we do. We don't do it every day. We like to do that, actually it’s a demonstration of our technology. We've got one of our guys use the wheelchair and he jumps in an exoskeleton and he thinks ‘Walk.’ And the device walks. There are videos of that online if you have a YouTube and things. It's a good demonstration because often, when you're fixing pain, there's nothing happening for somebody externally to see.
That pattern recognition for the walks, and the stands, and all the rest of them, that's why we do this for the demo. But the serious side of it is that we can recognise patterns and for other things as well. Whether that's dementia, or it's concussion, or its different types of anxiety. Machines, and with some smart machine learning or some AI, you can actually start to decode all of that stuff. We only get better at it every single day. Every time somebody uses a machine and does a session, they give us 1.4 million lines of data.
Lisa: Wow. You can interpret it. So you're going to be able to interpret, using the same device, you're going to be able to, in the future, not only deal with pain and chronic pain issues, you will be able to tell if someone's getting dementia and all these other things. What addictions may be or other issues that you might be able to help people to retrain their brain to do it. All within the same device but with different data sets coming through.
Richard: Different data sets, different linking up to different technologies as well. We mentioned that we can use it for stroke. Some of the work that's been done in stroke, Auckland University Technology has a fantastic project, and there’s the public state, BCI. We provide the technology, they provide the science, roughly speaking, that's how it's split. What we do is we look at some of these sorts of exercises when you’ve had your stroke. You do your basic rehabilitation exercises. We've put them into an app and if you look at a planned exercise, we'll see somebody learning to sit, to stand. We can see their intention to move one and a half to two seconds before they actually move.
We know they're going to move before they know they're going to move, basically. That signal follows the same pattern every time. To know that pattern recognition and 50 milliseconds before the move, we fire a small electrical stimulation in the nerves that they're thinking about. If you take something like foot drop after a stroke or somebody’s foot’s dragging but hasn't really–
Lisa: I’m dealing with that with mum.
Richard: Yeah. That has a really big effect on people's worlds getting smaller because if you fall when you walk, you'll tend to walk less. The less you walk, the less good you are at walking, and so it becomes a negative feedback loop to–
Lisa: I’ve got to get your help with that one, man.